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Dr. Andrew Rynne

Family Physician

Exp 18 years

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Does congestive heart failure its edema ?

I suffer from severe edema, fluid in lungs and around heart impairing my respiration heart also. Can someone explain to me, when a victim undergoes diuresis by drugs or ultrafiltration, exactly HOW DOES the water trapped within the limbs, tissues, etc, which traversed the veins capillaries in the first place - since the diuretics remove water content from the bloodstream, then HOW DOES the edema throughout the body go away, even if temporarily? doesn t it need to re-enter the bloodstream where it came out from? and how long for this to happen?? I know the diuretics and ultrafiltration have not a DIRECT effect to drain water from fatty tissues in my thighs, etc. I have painful pitting edema, legs bursting with water pressure internally. I don t respond to diuretic drugs I will not enter hospital. I am uninsured, and have no one to take me in if I lose my finances. I am unemployed cannot quality for ANY govt $$$ since I have funds of my own. Kindly reveal to me. clcalifo- thanks for kind suggestions about water w/lemon added. I will try it. MDs told me that this will be a sickness to the death. No matter how much water I remove, my defective heart will daily make more edema. I fear I may never catch Up - hospitals in NYC will not lower prices for me - cost is $5000 per day!!! this would leave me bankrupt. My landlord will evict me 1-2-3 into the street for non-payment of rent. This isNYC. Hospitals will sue me in court to pay their bills. They have frozen my bank accts before. NO thanks~!!! I pray that Jesus will let me die peacefully at home from the CHF -as I can t live with this pain in my limbs anymore. It happened from a HUGE heart attack. It s an illness which lead to death ,anyway. At 57 - I am an invalid, walking is so painful, my legs cant bend at all,my breath is gasping. So Ipray beg jesus christ to heal me or TAKE me Please pray for me. Thanks sonofsta- tell me - a peprson with CHF like me or your brother - how does the end happen? does their heart stop, or lungs choke up? I wonder what to expect. for me- the diuretics NEVER DID work - From my right leg there flows a steady stream of cold water day night -it burst thru the skin and spills constantly.I wear incontinence pads to catch this drip. Were your brother father able to walk freely go in and out where they wished ? And how DID hospitals drain their fluids??? Thru drugs?? I wonder how they coped on a daily basis. There is NO CURE for this illness. It can only end in one way. Please pray for me - I want Jesus to take me soon rather than live as an invalid.
Mon, 14 Dec 2009
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  User's Response
Danny - I am sorry that you are not doing well and that you're having financial troubles. You are right, diuretics and ultrafiltration can only remove fluid that is in your bloodstream. However, when you are in heart failure, fluid building up in your tissues means you have too much fluid in your bloodstream as well. As you remove the excess fluid in the bloodstream, it allows the fluid in your tissues to better move through the LYMPHATIC SYSTEM and empty into your bloodstream through the THORACIC DUCT where it can be removed as well. (We all have SOME fluid in our tissues, and the lymphatic system is the normal route through which this fluid circulates.) If your diuretics aren't helping, that may be because you have so much extra fluid that your gut is edematous too. When this happens, your body's ability to absorb the medicine decreases. It becomes a vicious cycle. You become so edematous that you can't absorb the medicine needed to treat your edema... so it gets worse... and worse... and worse. When this happens, you need to get IV diuretics to get you back on track and this can only be done in a hospital setting! What others have said is true. Congestive heart failure is VERY SERIOUS and you need to be seen and treated by a cardiologist. (First, though, you need to make sure that heart failure is indeed your problem! Is this what a doctor has determined in the past?) If you are indeed suffering from heart failure and you are not being treated, I hate to say it, but you have a very high chance of dying in the next few years! Medical studies estimate the risk of dying in the next year to be 30-50% if you have advanced heart failure!!! Even in less severe cases, the risk of dying in the next five years is 40-50%! I know money may be tight, but I urge you to make an appointment with a cardiologist. They can put you in touch with a social worker who can help you find ways to pay for health care. There is no point in saving your money if you won't be around to spend it in a year! I hope that helps, Danny. Please feel free to email me if there's anything I can help you with. MORE INFO: Danny... my heart goes out to you. Listen, I think you need one hospitalization to get the excess fluid off. AFTER you are close to your normal weight, you can prevent excess fluid by taking your diuretics and CLOSELY WATCHING your salt intake and fluid intake. No more than 2g of salt per day and no more than 2 liters of fluid a day (that means water, juice, popsicles, ice chips, etc). Diuretics are very effective for taking off fluid, but if you are putting it right back by drinking tons of water, you will not make any progress. Also, you can weigh yourself every day and if your weight starts creeping up, you can take extra doses of the diuretic as instructed by your doctor (this can usually be done over the phone) to stay on target. If you are meticulous, you have a very good chance of preventing this sort of fluid build-up in the future but ONLY if you get the extra fluid removed by IV diuretics first! Right now, you're beyond the point of oral diuretics and fluid/salt restriction! If you want to know, the two ways that people with heart failure die are progressive heart failure and sudden death due to an arrhythmia, and both are more or less equally common. Progressive heart failure is slow and miserable. Sudden death is nearly instantaneous. BUT I think your quality of life will be infinitely better if you can eke out ONE hospitalization for the fluid excess. After that, if you are very careful, you may be able to prevent yourself from getting to this point again and perhaps avoid the need for another hospitalization.
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